Non-Adherence To Diabetic Treatment And Its Effect On Glycemic Control, Study At A Rural Hospital Of Tiruchirappalli, Tamilnadu,India

摘要

Objective: To study the Non-Adherence of the diabetic patients to the medical management in terms of diet, exercise and drugs and its effect on glycemic control.Materials and Methods: One hundred diabetic patients, randomly selected, excluding juvenile diabetes and gestational diabetes; age ranging between 30 – 75 years were interviewed using a standardized questionnaire.Results: The adherence was good with drugs & poor with exercise. Adherence was higher in males than in females. Among the 81(81%) patients following diet, exercise and drugs, 32(39%) had good adherence, 41(51%) and 8(10%) had fair and poor adherence respectively. All the eight (100% ) patients with poor adherence had poor glycemic control, while 33(80.5%) patients with fair and 6(18.75%) patients with good adherence had poor glycemic control. The awareness was slightly better in the group with positive family history. The number of patients having regular practice of monitoring blood glucose level, blood pressure and weight was74(74%),46(46%) and52(52%) respectively. Conclusion: The study confirms that good adherence to diabetic management is the cornerstone for good glycemic control and to ultimately reduce its complications .The study reveals the necessity of knowledge6 for the patients about the disease and its progress. Introduction Diabetes mellitus is one of the alarming non communicable medical and public health problems threatening India’s health scenario. World Health Organization (WHO) predictions put the figure at 40 million diabetic Indians by 2010 and 60 millions by 2025. Adherence is affected by many factors related to the patient and the disease1. The developed countries have a good diabetic education program which includes the treating physician, a diabetic nurse, a diabetic educator, a diabetic counsellor, a dietician which are all lacking in a developing country2. This in turn reflects as poor patient adherence to diabetic management in developing countries. Non-adherence to treatment protocols is of particular interest and significance in the diabetic population. The reasons for the patient’s non-adherence1 to therapy should be explored. The diabetic treatment regimen requires active attention to various areas such as diet, exercise, drugs and self monitoring of blood glucose. Materials And Methods The study was carried out randomly among diabetic patients who visited the medicine out patient department in Chennai Medical college Hospital& Research centre, Tiruchirapalli, Tamilnadu, India from December 2010 to May 2011. A proper Ethics approval from the Institutional Ethics Committee of Chennai Medical College Hospital& Research Centre was obtained. One hundred (100) diabetic patients were included in the study, after excluding the patients with type1 diabetes and gestational diabetes. Among the patients included, there were 56 male and 44 females. The age of the patients ranged between 30–75years.On the day of visit to the out patient department, a standardized questionnaire covering the educational level, family history, life style factors, degree of adherence to physician’s advice, medications and complications if any, was completed by an interview with the patients. The questionnaire also included a column for the patients to express their knowledge about diabetes mellitus and its associated complications, which was helpful for the attitude analysis of the subjects. From the patient’s case reports complete details about their previous blood glucose levels, associated diseases and diabetic complications were noted. For analyzing the patients, the rate of adherence was classified into 3 categories such as good, fair and poor . ADHERENCE WITH DIET: Good – strictly following the dietary schedule Fair – often did not following the dietary schedulePoor – did not follow at all.ADHERENCE WITH EXERCISE:Good – walking minimum for 30-60 min/day at least for 3-4 days/week.Fair – walking for minimum of less than 3 days in a week.Poor – did not going